Brain tumor

Definition
• An abnormal growth of
tissue found inside the
skull.
 Systems Affected
• The nervous system
specifically the
CENTRAL NERVOUS
SYSTEM.
– BRAIN
– SPINAL CORD
 Classification
Primary
• - Originating in the
brain.
• - Named after by their
location, the type of cell
they are made of, or
both.
 Types
1. Intracerebral Tumors – Glioblastoma Multiforme –
the fastest growing and
• Gliomas - Tumor arising most malignant type of
from glial cells, which tumor usually found in
forms the supporting the cerebrum area of the
tissue of the CNS. brain.
• Gliomas are categorized – Oligodendrocytoma-
maybe low or high grade
and graded according to
its degree of malignancy:
– Astrocytomas – most
common type of glioma.
2. Tumors arising from
supporting structures
3. Developmental tumors
4. Metastatic lesions
 Symptoms
-Seizures - Behavioral and
- Nausea and vomiting Cognitive symptoms
- Headaches - Motor Problems
- Visual and auditory - Balance difficulties.
problems
 Assessment/Diagnostics
• neurological • Lumbar puncture
examination • Biopsy (required for
• imaging studies and test definitive diagnosis.)
(CT scan, MRI, PET)
• EEG
(electroencephalogram)
 Treatment
• Surgery
• Radiation
• Chemotherapy
 Surgical Management
Goal: • Transsphenoidal
– Remove or destroy the microsurgical removal
entire tumor without (pituitary adenomas)
increasing the neurologic
• craniotomy
defect or to relieve
symptoms by partial
removal.
 Radiation
• Brachytherapy
– Iodine 131
• Gamma Knife
 Nursing Management
• Assess gag reflex and • Seizure precaution
ability to swallow • Motor function
• Neurologic assessment assessment
• Orientation to 3 spheres
 Cerebral Metastases
Signs and Symptoms: • Altered mentation
• Headache • seizures
• Gait disturbances
• Visual impairment
• Personality changes
 Medical Management
Goal: • Radiation therapy – 3 –
• Palliative care 6 months

Survival Rate:
• No treatment – 1 month
• Corticosteriod treatment
– 2 months
• Medications: – Chemo Drugs:
– Corticosteroids • Carmusine (BCNU)
• Lomustine (CCNU)
(dexamethasone,
• PCV (triple drug combo
prednisone)
of procarbazine HCl,
– Osmotic agents lomustine and vincristine)
(mannitol)
– Antiseizures (phenytoin)
 Nursing Management
Assess: Intervene:
• Baseline neurologic • Compensating for self –
status care deficit
• Nutritional Status • Improving nutrition
• Relieving anxiety
 Spinal Cord Tumor
Classification:
1. intramedullary lesions
(within the spinal cord)
2. Extramedullary –
intradural lesions
3. Extramedullary –
(within or under the extradural lesions
spinal dura) (outside the dural
membrane)
Signs and Symptoms
• Localized or shooting
pains • Progressive loss of
• Weakness motor function
• Loss of reflexes above • paralysis
the tumor level
 Assessment and Diagnostics
• Neurologic examination • X – rays
• Radionuclide bone
scans
• MRI (most sensitive
diagnostic tool)
 Medical Management
• Surgery (primary
treatment)
• Decompression of the
spinal cord
• Chemotherapy
• Radiation therapy
 Nursing MAnagement
Pre – operatively: Post – operatively:
• Recognition of • Managing Pain
neurologic changes • Monitoring and
• Assessing weakness, Managing
muscle wasting, Complications
spasticity
• Teaching breathing
technique
Head Injury
 Head Injury
• Any injury that results • Includes injury to the
in damage to the brain scalp, skull or brain
or trauma to the head. • Most common cause of
• Also called traumatic death from trauma in the
brain injuries which are US.
quite common.
 Forms
1. Primary Injury: 2. Secondary Injury:
– Initial damage to the – Evolves over the ensuing
brain that results from hours and days after the
the traumatic event initial injury and
– Includes: contusions, primarily due to brain
lacerations, torn blood swelling or bleeding.
vessels from impact.
 Signs and Symptoms
• Lose of consciousness • Headache that may be
• Bleeding severe
• Slowed breathing • Increased drowsiness
• Confusion • Slurred speech
• Seizures • Stiff neck
• Skull Fracture • Swelling at the site of the
• Fluid drainage from the injury. 
nose, mouth or ears that is
clear or bloody.
 Scalp Injury
• Isolated Scalp Trauma – generally
a minor head injury.
Diagnosis:
Scalp profusely bleed when injured
because the constriction of blood • Physical examination
vessels is poor.
Results of Trauma:
• Inspection
• Abrasion – brush/wound • Palpation
• Contusion- bruise
• Laceration- open or cut wound
• Subgaleal hematoma (beneath the
layers of the scalp)
 SKULL FRACTURE
Classfication:
• Break in the continuity of • Linear
the skull caused by forceful • Comminuted
trauma. • Depressed
• It may occur with or without • basilar
damage to the brain.
SIGNS OF SKULL
FRACTURE: Assessment and diagnostics:
• Bruising or deformity of the • X-ray
skull
• CT scan
• Discoloration under the eye
and on forehead • MRI
• A dark mark below the ear • Cerebral angiography
(battle sign)
• Unequal pupils
• Bleeding from the ear
• Clear or bloody fluid from the
nose
 Medical Management
• Close observation is • Avoid sneezing or
essential coughing (for basal
• Surgery (if necessary) fracture)
• Antibiotic therapy • Elevate head 30 degrees
• BT (if indicated
 Brain Injury
Closed (blunt) brain injury Open brain injury
• When the head accelerates • Occurs when an object
then rapidly decelerates or penetrates the skull, enters
collides with another object the brain and damages the
and brain tissue is damaged soft brain tissue in its path
but no opening through the (penetrating injury), or a
skull or dura. blunt trauma to the head is
so severe that it opens the
scalp, skull and dura.
 Concussion
• Temporary loss of S/Sx:
neurologic function with Postconscious syndrome:
no apparent structural • Dizziness
damage.
• Irritability
• Frontal lobe – bizarre
irrational behavior • Anxiety
• Temporal – temporary • Lethargy
amnesia or disorientation • Headaches
WOF:
• Difficulty awakening
• Difficulty speaking
• Confusion
• Severe headache
• Vomiting
• Weakness on one side
of the body
Contusion Diffuse Axonal Injury
• More severe injury • Involves widespread
• The brain is bruised with damage to the axons in the
possible surface cerebral hemispheres,
hemorrhage. corpus collosum and
brainstem
 Intracranial Hemorrhage
Classification:
• Hematomas that develop • Epidural (above the dura)
within the cranial vault are • Subdural (below the dura)
the most serious brain • Intracerebral (within the
injuries. brain)
 Epidural Hematoma
S/Sx: Treatment:
• Momentary loss of • Trephination
consciousness followed by • Craniotomy
lucid interval
• Drain insertion
• Increased ICP
• Signs of compression
(deterioration of
consciousness, dilation and
fixation of the pupils or
paralysis of extremity
 Subdural Hematoma
Acute and Subacute Chronic
• Associated with major head • Most frequent among
injuries elderly
• S/SX (over 24 – 48 hours) • S/SX
– Changes in LOC – Severe headache
– Pupillary signs – Personality changes
– Hemiparesia – Mental deterioration
– Coma – Focal seizures
– Inc BP, Dec HR, slowing RR
 Intracerebral Hematoma
• Commonly seen in head
injuries when force is
exerted to the head over
a small area.
 Management
Assessment Diagnosis
• Initial physical and • CT scan
neurologic examination • MRI
• PET
• X – ray (in case of SCI)
Treatment of inc ICP Supportive Measures
• Surgery • Ventilatory support
• Maintain adequate O2 • Seizure precaution
• Elevate head of bed (benzodiazepines)
• Maintain normal blood • F&E maintainance
volume • Nutritional support (NGT
feeding)
• Pain and anxiety
management
 Nursing Management
• Monitor for declining • Maintaining airway
neurologic function – Elevate head of bed with
– LOC consideration to
– Vital signs aspiration
– Motor function – Suctioning
– Other neurologic signs – Monitor ABG values
(pupils, anosmia, epilepsy,
etc.)
Promote adequate nutrition Maintain Body temp
• Parenteral nutrition via • Monitor frequently
central line • Cooling blankets
• NGT feeding • TSB
Maintain skin integrity
• Reposition pt every 2 hours Monitor and mange potential
complications
• Assess body surface and • Dec, cerebral perfusion
document skin integrity • Cerebral edema and herniation
• Provide skin care • Impaired oxygenation and
ventilation
• Impaired fluid & electrolyte
Prevent sleep pattern and nutritional balance
disturbance • Post traumatic seizures